medicina57巻12号

2020年11月発行

特集 膠原病・自己免疫疾患を「見える化」する

臨床から見える化する 【SLE】

SLEの管理を見える化する

著者： 梶山浩¹

所属機関： ¹埼玉医科大学リウマチ膠原病科

ページ範囲：P.2070 - P.2076

文献概要

Point
◎全身性エリテマトーデス（SLE）は全身性自己免疫疾患であり，B細胞の過剰かつ異常な活性化から，多様な自己抗体が産生され，さまざまな臓器障害をきたす．
◎診断のための分類基準は，1997年ACR改訂分類基準と2012年SLICC分類基準を併用している．現在，2019年EULAR/ACR分類基準について本邦での検証が進められている．
◎SLEDAI，BILAGでSLEの疾患活動性を，ISN/RPS分類でループス腎炎の組織学的重症度を判定し，ACRガイドライン，EULARリコメンデーション，本邦のSLE診療ガイドラインを参考に治療方針を決定する．
◎グルココルチコイド，免疫抑制薬のシクロホスファミド，アザチオプリン，タクロリムス，ミコフェノール酸モフェチル，生物学的製剤のベリムマブと，処方できる薬剤の種類も増え，治療は進歩してきた．
◎低疾患活動性を目標に治療し，不可逆的な臓器障害を最小限にする．治療の進歩により近年では10年生存率が90％を超えている一方で，長期のステロイド投与による合併症管理，難治性病態の治療が課題である．

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